Low ALT Levels Independently Associated with 22-Year All-Cause Mortality Among Coronary Heart Disease Patients.

Abstract

Low alanine aminotransferase (ALT) blood levels are known to be associated with frailty and increased risk of long-term mortality in certain populations. However, the contribution of this marker to long-term outcome has not been assessed in patients with chronic coronary heart disease. The aim of the current study was to assess the association between low ALT values and long-term, 22.8-year, all-cause mortality in this population. We examined the association of low ALT (<17IU/l) with long-term all-cause mortality in the Bezafibrate Infarction Prevention (BIP) Registry population. Appropriate laboratory and survival data were available for 6,575 patients, without known liver pathology, included in the BIP registry, with a median follow-up period of 22.8years. The cumulative probability of all-cause mortality was significantly higher in the low ALT group compared with patients with higher ALT levels (65.6% vs. 58.4%; log-rank p < 0.001). Consistently, multivariate analysis, adjusted for multiple established predictors of mortality in this population, demonstrated that low ALT is independently associated with 11% greater long-term (22.8years) mortality risk [HR 1.11 (95% confidence interval: 1.03-1.19; adjusted p < 0.01)]. Low ALT levels are associated with increased long-term mortality among middle-aged patients with stable coronary heart disease. This association remained statistically significant after adjustment for other well-established risk factors for mortality in this population.